In this issue

The first of this year’s major scientific conferences – the Conference on Retroviruses and Opportunistic Infections (CROI) held in Los Angeles in February –suggests that the more we learn about HIV and the drugs used to treat it, the more we need to know.

For example, we used to think that anti-HIV drugs were the ‘cause’ of the increased numbers of heart attacks that some HIV-positive people have been experiencing in the past few years. Last year’s SMART study, however, suggests that it’s not just the drugs, but HIV (or at least stopping anti-HIV drugs) that increases the risk.

Until CROI, we assumed that lipoatrophy (fat loss in the face and limbs) was due to nucleoside analogues, notably d4T and, to a lesser extent, AZT. Now we discover that efavirenz (Sustiva) may play a role, since the risk of lipoatrophy doubled in those taking it no matter which nucleoside they also took.

It’s important not to panic when new information comes in about drug side-effects because they may be contradicted by the next study. After all, if we’ve learned one thing in a quarter of a century of HIV disease, it’s this: in the end, HIV is much more harmful than any anti-HIV drug.

page 3 In this month's Upfront, we highlight recent studies examining the links between HIV and some cancers, and suggest some things you can do to reduce the risks.

page 4 Do your anti-HIV drugs ‘play well with others’? asks Derek Thaczuk in our main article on Drug interactions. He talks to Heather Leake Date, Principal Pharmacist for HIV and Sexual Health at Brighton and Sussex University Hospitals, about the challenges of drug interactions and how best to deal with them.

page 9 In Measuring drug levels, Heather Leake Date explains about therapeutic drug monitoring (TDM), and who might benefit. There are also some real-life examples to illustrate that although TDM isn’t a routine test, it can help in certain situations.

page 12 In a special four-page News in Brief, we focus on the some of the most important studies presented at the recent CROI. Promising new data were presented on several new drugs, including those for people who have HIV that is resistant to some or all currently approved drugs. Also featured is a report on a study that found a surprising link between efavirenz (Sustiva) and lipoatrophy.